Comparative safety and efficacy of low dose ketamine and opioids for acute pain management at the emergency department

Abstract

Background: Pain is a complex phenomenon for which many pharmacological agents have been discovered and utilized for pain relief. Ketamine is a more preferred pain reliever over opioids in the emergency department (ED). The aim of this study was to compare the safety and efficacy of low dose ketamine (LDK) with morphine (opioid) for pain relief among patients presenting to the ED. Methodology: A prospective, cohort study was conducted over a sample of 280 patients presented with acute pain to the ED, Ziauddin University Hospital, Karachi. These patients were then divided into two groups via simple random sampling with randomization being assured using an online randomizer software tool. The 1st group (n=140) was given 0.2 mg/kg of LDK while 0.1 mg/kg of intravenous morphine (opioid) was given to the 2nd group (n=140). The pain intensity was measured using the Visual Analogue Scale (VAS) from admission to 60 mins, the records were taken after every 15 mins. The adverse events (AE's) were also recorded for both groups. The data was then analyzed using SPSS Version 21 & Microsoft Excel 2016. Results: Out of 280 patients enrolled in the study, there was male majority i.e. 76.07% while the remaining were females with the mean age of 29±7 years. Within 15 minutes of initial dose administration in both groups, a marked reduction in pain intensity was observed. Reduced respiratory rate, pruritus and decreased O2 saturation were common AE's observed, which were comparatively higher among patients receiving morphine as compared to ketamine. Conclusion: The efficacy of morphine (opium) and LDK is similar in alleviating pain in an emergency setting, however, LDK is visibly safer than its opioid counterpart and thus may be used as a safer alternative.

Clinical Response of Nuberol Forte® for Pain Management With Musculoskeletal Conditions in Routine Pakistani Practice (NFORTE-EFFECT)

“…In the South-East Asian region, 369 million are affected by musculoskeletal conditions [3]. There is a scarcity of data representing disease prevalence in Pakistan; however, multiple studies focused on specific professional communities with high risks to musculoskeletal disorders [4][5][6]. Musculoskeletal pain is instigated by almost 150 conditions primarily involving the joints, bones, muscles, and spine and other aspects like inflammatory diseases and vasculitis [3][4][5][6][7][8].…”

“…Multiple studies evaluating the clinical response of paracetamol fixed-dose with different combinations (ibuprofen, tramadol, diclofenac, aceclofenac) as an analgesic have been conducted [18][19]. Despite the widespread use of a combination of paracetamol with orphenadrine, no local data are available to evaluate the effectiveness, safety, and tolerability of fixed-dose orphenadrine plus paracetamol in managing musculoskeletal pain [4][5][6]. Only one publication exists in the past, including the same brand with different strengths and indications [20].…”